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A cervical empyema due to Panton-Valentine leukocidin Staphylococcus aureus. Med Mal Infect 2016; 46:326-7. [PMID: 27112520 DOI: 10.1016/j.medmal.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 02/17/2016] [Accepted: 03/17/2016] [Indexed: 11/19/2022]
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2
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[Gemella haemolysans endocarditis in a patient with a bioprosthetic aortic valve]. Med Mal Infect 2016; 46:61-3. [PMID: 26725541 DOI: 10.1016/j.medmal.2015.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/18/2015] [Accepted: 11/25/2015] [Indexed: 12/16/2022]
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3
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Mupirocin/chlorexidine to prevent methicillin-resistant Staphylococcus aureus infections: post hoc analysis of a placebo-controlled, randomized trial using mupirocin/chlorhexidine and polymyxin/tobramycin for the prevention of acquired infections in intubated patients. Infection 2014; 42:493-502. [PMID: 24464791 DOI: 10.1007/s15010-013-0581-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The reduction in acquired infections (AI) due to methicillin-resistant Staphylococcus aureus (MRSA) with the mupirocin/chlorhexidine (M/C) decontamination regimen has not been well studied in intubated patients. We performed post hoc analysis of a prior trial to assess the impact of M/C on MRSA AI and colonization. METHODS We conducted a multicenter, placebo-controlled, randomized, double-blind study with the primary aim to reduce all-cause AI. The two regimens used [topical polymyxin and tobramycin (P/T), nasal mupirocin with chlorhexidine body wash (M/C), or corresponding placebos for each regimen] were administered according to a 2 × 2 factorial design. Participants were intubated patients in the intensive care units of three French university hospitals. The patients enrolled in the study (n = 515) received either active P/T (n = 130), active M/C (n = 130), both active regimens (n = 129), or placebos only (n = 126) for the period of intubation and an additional 24 h. The incidence and incidence rates (per 1,000 study days) of MRSA AI were assessed. Due to the absence of a statistically significant interaction between the two regimens, analysis was performed at the margins by comparing all patient receiving M/C (n = 259) to all patients not receiving M/C (n = 256), and all patients receiving P/T (n = 259) to all patients not receiving P/T (n = 256). RESULTS Incidence [odds ratio (OR) 0.39, 95 % confidence interval (CI) (0.16-0.96), P = 0.04] and incidence rates [incidence rate ratio (IRR) 0.41, 95 % CI 0.17-0.97, P = 0.05] of MRSA AI were significantly lower with the use of M/C. We also observed an increase in the incidence (OR 2.50, 95 % CI 1.01-6.15, P = 0.05) and the incidence rate (IRR 2.90, 95 % CI 1.20-8.03, P = 0.03) of MRSA AI with the use of P/T. CONCLUSION Among our study cohort of intubated patients, the use of M/C significantly reduced MRSA AI.
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[Soft tissue infection associated with bacteremia caused by Shewanella putrefaciens]. ACTA ACUST UNITED AC 2011; 60:e27-9. [PMID: 21616609 DOI: 10.1016/j.patbio.2011.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 04/11/2011] [Indexed: 11/30/2022]
Abstract
Shewanella putrefaciens is rarely involved in human infectious disease. We report here a case of soft tissue infection with bacteremia on a patient with risk factors (liver cirrhosis, diabetes mellitus).
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[Epidemiology of healthcare-associated infections due to MRSA in Brest University Hospital from 2004 to 2007. Impact of hydroalcoholic gel and antibiotics consumptions]. PATHOLOGIE-BIOLOGIE 2011; 59:e1-e5. [PMID: 21295413 DOI: 10.1016/j.patbio.2010.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 10/15/2010] [Indexed: 05/30/2023]
Abstract
UNLABELLED The fight against healthcare-associated infections is based on preventive measures of multidrug resistant bacteria diffusion. Hand hygiene is the simplest and the most effective preventive measure to reduce cross-transmission of infectious agents. Hydroalcoholic solutions for hand hygiene was recently introduced in the University Hospital of Brest (France). The aims of the study were: to describe the epidemiology of healthcare-associated infections due to methicillin-resistant Staphylococcus aureus (MRSA); to determine the annual consumptions of antistaphylococcal antibiotics; and to discuss the relation between consumption of antiseptic products or antibiotics and the epidemiology of MRSA. METHODS A retrospective epidemiological and pharmaco-epidemiological study was realized from January 2004 to December 2007 in the University Hospital of Brest (France). It allowed to bring to light the cases of healthcare-associated infections due to MRSA and to quantify the consumptions of hang hygiene products and antistaphylococcal antibiotics. RESULTS this retrospective study showed a decrease of healthcare-associated infections due to MRSA and an increase of the consumption of hydroalcoholic solutions. Antistaphylococcal resistance rates also decreased in a context of fall of the global antibiotics consumption in the hospital.
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Efficiency of CHROMagar-MRSA in detecting meticillin-resistant Staphylococcus aureus in a routine setting. J Hosp Infect 2008; 70:388-9. [DOI: 10.1016/j.jhin.2008.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 09/02/2008] [Indexed: 11/15/2022]
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Q-02 Dermohypodermite et bactériémie à Schewanella putrefaciens. Med Mal Infect 2008. [DOI: 10.1016/s0399-077x(08)73209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Antibiothérapie des exacerbations de bronchopneumopathie chronique obstructive : analyse critique des essais cliniques. Med Mal Infect 2006; 36:690-6. [PMID: 16824719 DOI: 10.1016/j.medmal.2006.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 05/19/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The authors had for aim to assess the role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS Comparative antibiotic trials were collected through systematic search on Medline data base--well-designed studies were selected. RESULTS Eight equivalence studies were selected. No clear difference between antibiotics was demonstrated. The shortest treatment was as effective as the longest. CONCLUSION No antibiotic has demonstrated its superiority. A new generation of antibiotic comparative trials for exacerbation of COPD is clearly needed.
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[Pasteurella multocida meningitis following neurosurgery]. Med Mal Infect 2006; 36:223-5. [PMID: 16630702 DOI: 10.1016/j.medmal.2006.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Accepted: 01/27/2006] [Indexed: 10/24/2022]
Abstract
Pasteurella multocida is a rare cause of meningitis. We report a case of P. multocida meningitis following a recent neurosurgery procedure and review the 32 cases previously described.
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C-12 Étude comparative de la pneumocystose (PPC) au cours et en dehors du sida. Med Mal Infect 2004. [DOI: 10.1016/s0399-077x(04)90157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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CL7-06 Évaluation de la qualité de l'antibiothérapie: Une enquête un jour donné. Med Mal Infect 2004. [DOI: 10.1016/s0399-077x(04)90072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Objectives. A retrospective multicentric study was conducted over a five-year period to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating hematologic malignancies.Results. The study included 60 HIV-negative patients with 18 non-Hodgkin's malignant lymphoma (30%), 13 chronic lymphocytic leukaemia (21.7%), 10 acute leukemia (16.6%), 5 multiple myeloma (8.3%), 4 Waldenström's diseases (6.6%), 4 chronic myeloid leukemia (6.6%), 3 myelodysplasia (5%), 2 Hodgkin's diseases (3.3%) and 1 thrombopenia. Bronchoalveolar lavage was diagnostic in all patients. Forty-nine patients received cytotoxic drugs (81.7%), 25 (41.7%) a long-term corticotherapy and 15 (25%) underwent bone marrow transplantation. Twenty-seven patients (45%) required admission in the intensive care unit, 35 (58.3%) received an adjunctive corticotherapy and 18 mechanical ventilation (30%). Twenty patients (33.3%) died of PCP. A previous long-term corticotherapy (p=0.04), high respiratory (p=0.05) and pulse rates (p=0.02), elevated C reactive protein (p=0.01) and mechanical ventilation (OR=13.37; IC: 1.9-50) were associated with a poor prognosis. Adjunctive corticotherapy did not modify the prognosis.Conclusions. These results suggest that PCP can occur during the course of various hematologic malignancies, not only lymphoproliferative disorders. Prognosis remains poor. The diagnosis should be advocated more frequently and earlier to improve the prognosis.
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Analysis of underlying diseases and prognosis factors associated with Pneumocystis carinii pneumonia in immunocompromised HIV-negative patients. Eur J Clin Microbiol Infect Dis 2002; 21:523-31. [PMID: 12172743 DOI: 10.1007/s10096-002-0758-5] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this retrospective study was to determine the underlying diseases associated with Pneumocystis carinii pneumonia (PCP) in immunocompromised HIV-negative patients and to identify prognosis factors in this population. One hundred three cases of PCP were diagnosed over a 5-year period. Diagnosis was established on the basis of clinical features and by detection of Pneumocystis carinii cysts in bronchoalveolar lavage fluid. Underlying diseases comprised hematologic malignancies (n=60; 58%), inflammatory diseases (n=27; 26%), and solid tumors (n=18; 17.5%); 9 (8%) patients were solid organ transplant recipients. Seventy-one (69%) patients received cytotoxic drugs, 57 (55%) were treated with long-term corticotherapy, and 15 (14.7%) underwent bone marrow transplantation. Fifty-eight (56%) patients were admitted to the intensive care unit, and 52 (41%) required mechanical ventilation. Thirty-nine (38%) patients died of PCP; data from these patients were compared with those from surviving patients. The following factors were associated with a poor prognosis: high respiratory rate (P=0.005), high pulse rate (P=0.0003), elevated C-reactive protein (P=0.01), elevated serum lactate dehydrogenase level (P=0.02), and mechanical ventilation (OR, 14.4; 95%CI, 5-50). The results suggest that PCP can occur during the course of many immunosuppressive diseases, particularly various hematologic malignancies. The diagnosis of PCP should be considered more frequently and advocated earlier in immunocompromised HIV-negative patients, since prompt diagnosis may improve the prognosis of these patients.
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Abstract
AIMS Syncope is a frequent and potentially dangerous symptom. The epidemiological data are based on series mainly collected 20 years ago in the U.S.A. and do not adequately assist in the management of patients admitted now for this symptom in Europe. METHODS AND RESULTS To evaluate prospectively the epidemiological aspects and the management of the patients admitted in the emergency department of an adult university hospital for a 'verified' syncope, charts of all the patients consecutively admitted between June 1999 and June 2000 were systematically reviewed by a member of the cardiology staff. Those with a loss of consciousness were selected and those with a definite syncope were included in the study group and followed until they were discharged from the hospital. Among the 37,475 patients who presented to the emergency department, 454 (1.21%) had a definite syncope. For 296 it was the first episode and 169 (mean age 43+/-23 years) were discharged straight away; 285 (mean age 66+/-19 years; P<0.0001) were admitted to internal medicine (n=151), cardiology (n=65), neurology (n=44), endocrinology (n=14) and surgery (n=11) services. In 75.7% of all the patients a diagnosis was reported but it was inadequate to explain a syncopal episode in 56 cases (16.3%). Management differed by department: 36% of the patients had 'neurological' investigations mainly in internal medicine and neurology. Except in cardiology very few had 'cardiological' investigations particularly tilt test and electrophysiological studies (5%). CONCLUSION Syncope is a frequent symptom but its cause often remains unknown partly due to inadequate management. Precise and simple guidelines are urgently needed.
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[Generalized livedo during severe chloralose poisoning]. Presse Med 2000; 29:1285. [PMID: 10923133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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[Prescription of beta-lactams for community-acquired broncho-pulmonary infections in adults. Observations in the hospital environment]. Presse Med 2000; 29:1159-65. [PMID: 10906933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Analyze beta-lactam prescription patterns used in hospitals for the treatment of community-acquired lower respiratory tract infections in adults. PATIENTS AND METHODS A prospective study was carried out over 4 months (October 1997 to January 1998) in 54 medical units caring for lung disease, internal medicine/infectious disease, geriatric and general medicine patients in 27 hospitals representative of the public facilities in France. Data were collected on the medical unit, the patients, and the antibiotic prescriptions, including discharge prescriptions. The cost analysis of antibiotic therapy took into account all antibiotics given to the patients during their hospital stay. RESULTS One thousand eighteen patients were included in the study: 266 were treated for acute bronchitis, 405 for bronchitis infection with underlying chronic respiratory disease, and 347 for pneumonia. Noteworthy findings included: low percentage of protocols within the medical units (25.3%), an unexpected frequency of hospitalization for acute bronchitis generally among elderly women, and prolonged intravenous antibiotic therapy and hospitalization (5 to 6 days and 9 to 12.5 days respectively). CONCLUSION This study confirms the need to reinforce measures aimed at optimizing antibiotic prescriptions in hospitals.
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Non-invasive continuous positive airway pressure in acute hypoxaemic respiratory failure--experience of an emergency department. Eur J Emerg Med 1998; 5:313-8. [PMID: 9827833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Non-invasive continuous positive airway pressure (CPAP) seems to decrease the need for intubation in patients with severe cardiogenic pulmonary oedema (CPO) in the intensive care unit. The goals of our study were to delineate indications for CPAP in the emergency department, and to confirm its usefulness in such a setting. We retrospectively assess the evolution of all patients ventilated under CPAP for an acute hypoxaemic respiratory failure over a 1-year period (n = 64 patients). Hypercarbia and respiratory acidosis were present in most patients with CPO (PaCO2 = 54.4+/-22.3 mmHg; pH = 7.27+/-0.13), according to respiratory exhaustion, although initial PaCO2 was low in the pneumonia group. There was a significant improvement of arterial blood gases after 1 hour of ventilation in the CPO group (PaO2 = 254.1+/-121.0 mmHg; PaCO2 = 44.0+/-12.6 mmHg; pH = 7.34+/-0.08; p < 0.0001 for both parameters). In the pneumonia group, oxygenation was also improved but with the persistence of a significant shunt (PaO2 = 157.6+/-84.4 mmHg). Fifty-four patients (84%) were considered as successfully ventilated under CPAP, with no need for intubation and a favourable evolution, mainly in the CPO group. No side effects were reported. In conclusion, CPAP is a useful and easy-to-use ventilatory device in the emergency department. It is now one of our first line treatments during prehospital and emergency care of patients with CPO.
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[Spontaneous positive end-expiratory pressure ventilation in elderly patients with cardiogenic pulmonary edema. Assessment in an emergency admissions unit]. Presse Med 1998; 27:1089-94. [PMID: 9767807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES Intubation and ventilatory assistance are often required in patients presenting severe hypoxemic respiratory distress, but may be contraindicated in elderly subjects due to an underlying condition. The aim of this study was to assess the feasibility, acceptability and contribution of early assistance with spontaneous positive end-expiratory pressure ventilation for elderly subjects admitted to an emergency unit for acute respiratory distress due to cardiogenic pulmonary edema. PATIENTS AND METHODS In our emergency admission unit, all patients with life-threatening hypoxemic respiratory distress are initially assisted with noninvasive spontaneous positive end-expiratory pressure ventilation using a standardized commercial device. We retrospectively analyzed the the files of all patients aged over 70 years who were treated with this standard protocol for cardiogenic pulmonary edema from April 1996 through September 1997. RESULTS During the study period, 36 patients aged over 70 years required ventilatory assistance according to the standard protocol. Intubation was not reasonable in most of the patients (n = 30). After 1 hour of ventilation, none of the patients developed clinical signs of life-threatening distress. Blood gases demonstrated improved oxygenation (AEPO2 = +184.9 +/- 105.4 mmHg; p < 0.000001). Thirty-two patients were considered to be cured (88.9%) and were discharged; the cardiovascular condition was fatal in 4 patients (11.1%). CONCLUSION The rapid improvement in clinical signs and blood gases as well as the final outcome suggests that early assistance with spontaneous positive end-expiratory pressure ventilation is warranted at admission for elderly patients with respiratory distress due to cardiogenic pulmonary edema. Compared with a control group of hospitalized patients cared for during the preceding year and who were not treated with the standard protocol, we also demonstrated a clear improvement in mortality (11% versus 20%).
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Intérêt de la radiographie standard utilisant l'incidence de Blondeau modifiée pour le diagnostic de sinusite en réanimation. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s1164-6756(98)80141-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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[A sociomedical geriatric assessment in the emergency units: an alternative to the hospitalization of aged patients?]. Rev Med Interne 1998; 19:85-90. [PMID: 9775122 DOI: 10.1016/s0248-8663(97)83417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elderly patients admitted to the emergency unit are usually hospitalized in medical units. Could a gerontologic evaluation in the emergency room lead to another solution than hospitalization? METHODS Since January 1993, a sociomedical geriatric reception has been operating in the emergency unit of the university hospital in Brest, France, every day from 10 AM. to 6 PM. Patients older than 75 years, dependent or at risk of dependence are examined by a geriatrician. The medical situation is evaluated. The nutrition status, the cognitive functions, the thymic functions, the gait, and the functional abilities are systematically studied. In the same time the social evaluation is realised by a social worker. RESULTS From January 1993 to December 1996, 1,514 patients have been cared for by the social medical team. Once the assessment of each patient was made only 49% of them actually had to be hospitalized in a medical department. The outcome of 100 patients discharged between January 1994 and June 1994 was evaluated one year after their discharge at home, 11 patients were rehospitalized. The reason for rehospitalization were different from the reasons for the first hospitalization. CONCLUSION A gerontologic assessment in the emergency room permits to avoid hospitalization in 50% of the cases. One year after discharge at home only 11% of the patients were rehospitalized.
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Variations de densite du melange gazeux au cours de l'insufflation intratracheale continue. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0750-7658(97)86358-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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[Use of helium-oxygen gas mixtures in acute obstructive respiratory insufficiencies]. REVUE DE PNEUMOLOGIE CLINIQUE 1997; 53:177-184. [PMID: 9616816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Therapeutic use of helium has been described since 1930. Its main action is to reduce bronchial resistances and consequently overall respiratory work. Helium is substituted for nitrogen. The effects of inhaling a helium-oxygen mixture result exclusively from the physicochemical properties of helium: very low density, high kinetic viscosity. With the advent of selective bronchodilators, use of helium was rapidly abandoned until recently with new interest for the treatment of severe acute asthma. We review the literature on the physical properties of helium-oxygen mixtures and propose an analysis of their therapeutic use in severe acute asthma as well as other indications such as acute episodes of obstructive bronchopneumonia and obstruction of the upper airways. Due to the non-invasive nature of this technique, its easy use with spontaneous ventilation and the large body of theoretical data emphasizing its adaptation for therapeutic use, helium-oxygen gas mixtures offer an important therapeutic option for treating severe diseases with poor prognosis. A multicentric national study is under way to validate its use early by emergency ambulatory units for the treatment of severe acute asthma.
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[Recurrent polymicrobial septicemia disclosing aortic paraprosthetic infection]. Rev Med Interne 1995; 16:76-7. [PMID: 7871276 DOI: 10.1016/0248-8663(96)80670-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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High incidence of neurologic complications following rapid correction of severe hyponatremia in polydipsic patients. J Clin Psychiatry 1994; 55:349-54. [PMID: 8071304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients with self-induced water intoxication usually tolerate a large, rapid increase in plasma sodium without developing osmotically induced central pontine myelinolysis. However, we have previously reported a case of clinically suspected pontine myelinolysis in a patient with self-induced water intoxication. The purpose of our study was to investigate if a subgroup of these patients may also be vulnerable to neurologic complications of hyponatremia therapy. METHOD Over a 10-year period, we identified retrospectively 12 polydipsic patients having a total of 24 episodes of symptomatic hyponatremia with plasma sodium < or = 115 mmol/L. The mode of treatment, the kinetics of correction, and the neurologic outcome were recorded. The presence of alcoholism was noted. RESULTS Seven patients recovered uneventfully from 19 episodes of symptomatic hyponatremia. Five patients had delayed neurologic complications. Late therapy and/or respiratory arrest might have been associated with the complications for 2 patients. The other 3 patients experienced clinical features of central pontine myelinolysis leading to death in 1. Patients with neurologic complications had a higher maximal 24-hour increase in plasma sodium concentration (21.8 +/- 3.9 vs. 15.5 +/- 5.1 mmol/L, p < .02), and a higher incidence of both overcorrection to hypernatremia and chronic alcoholism, often associated with poor nutrition. All 5 patients became water intoxicated at home, and 2 patients with pontine dysfunction had subacute rather than acute hyponatremia. CONCLUSION A large rapid increase in plasma sodium may also be detrimental in patients with self-induced water intoxication when they are alcoholic, malnourished, and have nonacute hyponatremia.
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La numération des lymphocytes CD4 permet-elle de prévoir la survenue des pneumonies après transplantation rénale ? Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)81012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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CD4 T-lymphocyte counts as predictors of pneumonia after kidney transplantation. Transplant Proc 1993; 25:1491-2. [PMID: 8382878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Thrombus de l'aorte thoracique horizontale source de multiples embols chez une jeune femme. Rev Med Interne 1993. [DOI: 10.1016/s0248-8663(05)80254-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Infections pulmonaires à staphylocoque. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)80992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nocardiose cérébrale après une plaie oculaire traumatique. Rev Med Interne 1993. [DOI: 10.1016/s0248-8663(05)80244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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États de choc au cours de l'association diltiazem-β-bloquant. Rev Med Interne 1992; 13:80. [PMID: 1357727 DOI: 10.1016/s0248-8663(05)80016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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[Mycoplasma pneumoniae infections. A multicenter retrospective study of 182 cases]. Presse Med 1988; 17:1475-8. [PMID: 2971191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The spectrum of 182 hospital Mycoplasma pneumoniae infections, collected over a five-year period, is reviewed. The diagnosis was based on complement fixation test. Mycoplasma infection was encountered mainly in young people, mean age 29 years. Eighty-four per cent presented with an atypical pneumonia, 33 per cent had extrapulmonary manifestations mainly neurological and cutaneous. Acute respiratory failure occurred in 32 cases. Only 5 patients died. Macrolides or tetracyclines remain the most effective antibiotics but spontaneous recovery is usual.
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[Gastroduodenal necrosis in an hemolytic and uremic syndrome in the adult]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1988; 12:401. [PMID: 3384259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abces cerebraux multiples a Eikenella corrodens. Med Mal Infect 1988. [DOI: 10.1016/s0399-077x(88)80333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Antibioprophylaxis of Meningococcus group B meningitis. Must we implicate the use of the spiramycin]. PATHOLOGIE-BIOLOGIE 1987; 35:624-5. [PMID: 3302871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A fatal meningitis due to a spiramycin-sensitive group B Neisseria meningitidis occurred 13 days after interruption of a prophylactic antimicrobial therapy with spiramycin. The efficacy of recommended antimicrobial preventive treatment is discussed with regard to this case, other published cases and to the known partial and short term eradication of the naso-pharyngeal carriage of Neisseria meningitidis.
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[Attempt at preventive treatment of esophagitis caused by intubation during intensive care]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1987; 11:24-8. [PMID: 3556957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A randomized prospective trial was designed to evaluate the preventive treatment of esophagitis in 31 intensive care patients who had a nasogastric feeding tube for at least 10 days. Fourteen patients (group B) received no preventive treatment while 17 patients (group A) received 300 mg of cimetidine every 6 h intravenously and 11 g of colloidal aluminium phosphate every 4 h per os. All patients were fed a standard diet through their nasogastric tube at a constant rate of 30 Kcal/kg/day. Endoscopic controls at day 1 and 10 showed that the number of initial and final esophagitis was not different in groups B and A: 7 and 8 at day 1, 11 and 10 at day 10, respectively. The inefficiency of this preventive treatment suggested that acid gastroesophageal reflux is not a major factor in the occurrence of nasogastric feeding tube-induced esophagitis. However as esophagitis is associated with a more severe Knaus index and a greater number of gastric stress ulcer risk factors, it is suggested that decreased defense of the mucosa may be a key factor in the occurrence of this type of esophagitis.
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[Rhabdomyolysis in Mycoplasma pneumoniae infection with acute respiratory distress syndrome]. Presse Med 1984; 13:1097. [PMID: 6232539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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46
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[Fabry's disease. Diagnostic value of renal puncture biopsy in paucisymptomatic forms]. Presse Med 1983; 12:1874. [PMID: 6225088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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47
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[Rhabdomyolysis in alcoholics]. Presse Med 1983; 12:1673. [PMID: 6224160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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48
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[Acute pulmonary edema of hemodynamic origin in carbon monoxide poisoning]. LA SEMAINE DES HOPITAUX : ORGANE FONDE PAR L'ASSOCIATION D'ENSEIGNEMENT MEDICAL DES HOPITAUX DE PARIS 1983; 59:325-6. [PMID: 6302864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acute pulmonary edema is a frequent complication of carbon monoxide poisoning. The hemodynamic study of a case with major hypoxemia revealed the cardiac origin of the acute respiratory failure. Treatment associated diuretics, cardiotonic drugs and a positive end expiratory pressure. This treatment did not however prevent the occurrence of a transient anterolateral injury on EKG. The pathophysiology of pulmonary edema in carbon monoxide poisoning is discussed and evidence in favor of it's hemodynamic origin are exposed.
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